Goto Atsushi, Hamabe Koichi, Ito Shunsuke, Hashimoto Shinichi, Nishikawa Jun, Takami Taro
Department of Gastroenterology and Hepatology, Yamaguchi University Graduate School of Medicine, Minamikogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan.
Faculty of Laboratory Science, Yamaguchi University Graduate School of Medicine, Minamikogushi 1-1-1, Ube, Yamaguchi, 755-8505, Japan.
Esophagus. 2025 Jan;22(1):85-94. doi: 10.1007/s10388-024-01086-4. Epub 2024 Sep 17.
BACKGROUND/AIMS: Esophageal endoscopic submucosal dissection (ESD) performed under general anesthesia can potentially provide more stable treatment in difficult cases than that under sedation. We evaluated the clinical characteristics and outcomes of ESD performed under general anesthesia compared with those under propofol sedation and discussed the cases in which general anesthesia is recommended.
In total, 292 lesions in 265 consecutive patients undergoing esophageal ESD at Yamaguchi University Hospital from 2013 to 2023 were included in this retrospective study.
ESD was performed under general anesthesia for 92 lesions in 81 patients and under propofol sedation for 200 lesions in 184 patients. Tumor long-axis diameter was larger (39.8 ± 14.4 mm vs. 32.4 ± 9.9 mm, p < 0.01) and dissection speed was faster (10.5 ± 5.9 mm/min vs. 7.5 ± 4.2 mm/min, p < 0.01) in the general anesthesia group versus the sedation group. In the sedation group, a treatment history of pharyngeal cancer was significantly associated with a slower dissection speed (p = 0.037). The sedation group showed higher frequencies of hypoxemia (0% vs 9.8%, p < 0.01), interruption due to body movement (0% vs 13%, p < 0.01), and acute adverse events (21.7% vs 33.5%, p = 0.05). A treatment history of pharyngeal cancer was shown to be the significant factor contributing to acute adverse events (p = 0.018).
Esophageal ESD under general anesthesia can be a treatment option in patients with difficulty in performing stable procedures with propofol sedation. Especially in patients with a treatment history of pharyngeal cancer in whom ESD is more difficult to be performed and who are at higher risk for acute adverse events, general anesthesia can be considered.
背景/目的：与镇静状态下相比，全身麻醉下进行的食管内镜黏膜下剥离术（ESD）在困难病例中可能提供更稳定的治疗。我们评估了全身麻醉下ESD与丙泊酚镇静下ESD的临床特征和结局，并讨论了推荐全身麻醉的病例。
本回顾性研究纳入了2013年至2023年在山口大学医院连续接受食管ESD治疗的265例患者中的292个病变。
81例患者的92个病变在全身麻醉下进行ESD，184例患者的200个病变在丙泊酚镇静下进行ESD。与镇静组相比，全身麻醉组的肿瘤长径更大（39.8±14.4mm对32.4±9.9mm，p<0.01），剥离速度更快（10.5±5.9mm/分钟对7.5±4.2mm/分钟，p<0.01）。在镇静组中，咽癌治疗史与剥离速度较慢显著相关（p=0.037）。镇静组低氧血症发生率更高（0%对9.8%，p<0.01）、因身体移动导致的手术中断发生率更高（0%对13%，p<0.01）以及急性不良事件发生率更高（21.7%对33.5%，p=0.05）。咽癌治疗史被证明是导致急性不良事件的重要因素（p=0.018）。
全身麻醉下的食管ESD对于难以在丙泊酚镇静下进行稳定手术的患者可以作为一种治疗选择。特别是对于有咽癌治疗史、ESD操作更困难且急性不良事件风险更高的患者，可以考虑全身麻醉。
